Documentation for Level of Need (LON) — Inventory for Client and Agency Planning (ICAP) Increase

The following indicates the essential documentation to be submitted to the Texas Department of Aging and Disability Services (DADS), Access and Intake, IDD Waivers Program Enrollment/Utilization Review (PE/UR) to support a change in the ICAP ratings and an increase in services and supports for an individual in either the Intermediate Care Facilities for Persons with an Intellectual Disability (ICF/IID) program or the Home and Community-based Services (HCS) waiver program that would warrant an increase in the LON assignment. For extraordinary circumstances, please contact PE/UR for technical assistance or guidance through the PE/UR Message Line at 512-438-5055.

  • Form 8603, Level of Need (LON) Review/Increase Cover Sheet
  • A cover letter addressing the following:
    • Why the individual's ICAP score changed?
    • What preventive and/or assistance measures have been implemented to address the change in the individual's functioning?
  • A complete copy of the new ICAP response booklet and (computer) scoring sheet.
  • A complete copy of the old ICAP response booklet and (computer) scoring sheet.
  • Any pertinent and current (within the past year):
    • Incident, injury and restraint reports documenting serious occurrences or attempts to exhibit targeted behavior(s) that support the frequency and severity of the identified problem behavior(s) and reflect staff interventions.
    • Observation/progress notes/data sheets from home/residential and day program.
    • Psychological and psychiatric evaluations/updates.
    • Any team/interim staffings, along with any professional assessments that discuss the changes in the individual's functioning which would support the changes noted in the adaptive functioning.
    • Documents that would validate the new ICAP service level, such as an Independent Living and/or Basic Skills Assessment.
  • The latest annual staffing and Individual Program Plan (IPP) for ICF/IID or the Person Directed Plan and Implementation Plan for waiver programs.

Documentation should be mailed to:

Mailing Address:
Texas Department of Aging and Disability Services
Access & Intake
IDD Waivers Program Enrollment/Utilization Review
Mail Code: W551
P.O. Box 149030
Austin, TX 78714-9030

Physical Address:
Texas Department of Aging and Disability Services
Access & Intake
IDD Waivers Program Enrollment/Utilization Review
MC: W551
701 W. 51st St.
Austin, TX 78751

Fax: 512-438-4249
(Note: Do not fax more than 20 pages without prior approval.)